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Kai-Cheng Peng
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P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)
- Event: WCLC 2020
- Type: Posters
- Track: Targeted Therapy - Clinically Focused
- Presentations: 2
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P76.81 - Primary Resistance to EGFR-TKIs in Lung Adenocarcinoma harboring EGFR–RAD51 Fusion: A Brief Report (ID 3497)
00:00 - 00:00 | Author(s): Kai-Cheng Peng
- Abstract
Introduction
EGFR fusions are rare oncogenic mutations in lung cancer. Growing evidences support the efficacy of targeted therapy in such type of carcinoma. However, we found that some patients did not respond to EGFR tyrosine kinase inhibitors (TKIs).
Methods
Biological samples were sent for next-generation-sequencing(NGS)-based analysis targeting 139 cancer-related genes at the baseline and at disease progression respectively. Tumor response was determined according to RECIST 1.1.
Results
Totally 2 patients harbored de novo EGFR-RAD51 fusion at the Guangdong Lung Cancer Institute from January 1, 2017 to August 1, 2020. Both were diagnosed with metastatic lung adenocarcinoma and had poor progression-free survival to EGFR-TKIs. Patient 1, a 15-year-old female, presented with left chest pain. She was initially treated with erlotinib and progressed with newly lung and bone metastases after 2.1 months. Then she received chemotherapy with carboplatin and pemetrexed, and achieved stable disease after 4 cycles. At disease progression, she refused receiving anti-cancer treatment and died after 1 month. Patient 2, a 33-year-old male, presented with cough and headache. He was treated with first-line osimertinib. Clinical benefit was seen quickly and PS score was improved from 3 to 1 in 1 week. However, initial CT and MRI evaluation performed 4 weeks post-treatment showed newly left pleural effusion while lesions in lung, liver and brain were all shrunk. Then bevacizumab was added to osimertinib for 2 cycles. CT scan revealed liver metastases enlarged though lesions in the lungs and the brain were confirmed as partial response (PR). An extra EGFR amplification appeared in liver metastasis, so osimertinib combined with cetuximab was administered. But he progressed again after 1.3 months. At that moment, brain metastases also progressed dramatically. Mechanisms of resistance were not elucidated. Subsequently, he received the combination of carboplatin, pemetrexed and bevacizumab, resulting in a remarkable response in brain metastases, the liver metastases remained stable and primary lung lesion was still responding. Thus far, he is continuing treatment with chemotherapy and bevacizumab.
Conclusion
We suggested that not all lung adenocarcinoma patients harboring EGFR-RAD51 fusion are sensitive to targeted therapy. The therapeutic conception will need more real-world evidences. Chemotherapy plus bevacizumab might be an option for EGFR-RAD51 fusion-posive patients.
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P76.95 - Brief Report: Immunochemotherapy in Five Patients with EGFR Exon 20 Insertion Advanced Lung Adenocarcinoma (ID 3818)
00:00 - 00:00 | Presenting Author(s): Kai-Cheng Peng
- Abstract
Introduction
Epidermal growth factor receptor (EGFR) exon 20 insertions account for 4-9% of EGFR-mutated non-small-cell lung cancer (NSCLC). Effective therapies for patients with EGFR exon 20ins-mutant non-small-cell lung carcinoma remains uncertain.
Methods
We retrospectively analyzed survival data of patients with EGFR exon 20 insertion advanced lung adenocarcinoma treated with immunochemotherapy between June 2018 and July 2020 at the Guangdong Provincial People’s Hospital. EGFR mutation status was assessed by next-generation sequencing (NGS). Response was assessed according to Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1).The last follow-up date is August 1,2020.
Results
There were 5 patients with EGFR exon 20ins mutant lung adenocarcinoma from June 2018 to July 2020. They all received immunochemotherapy. The median progression-free survival (PFS) was 7.7 months (95%CI,2.1 - 13.2 months). Patient 1, a 52-year-old male, stage IVB with EGFR exon 20ins(p772_H773dup). The first-line treatment is pemetrexed, carboplatin and pembrolizumab. The primary tumor shrank (-24%) and brain metastasis disappeared after 4 cycles of treatment, then he underwent the surgery of the upper left lung resection. He showed a PFS of 7.0 months when PET/CT revealed multiple nodules in the left lung. Targeted therapy was followed, including afatinib and osimertinib. Unfortunately, he died for many severe complications.Patient 2, a 72-year-old male, stage IVB with exon 20ins(p.Asp770_Asn771). The first-line treatment was pemetrexed, nedaplatin plus bevacizumab and the second-line treatment was docetaxel plus carboplatin. Carboplatin, paclitaxel and bevacizumab plus atezolizumb were chosen as the following-line treatment. The best response was partial response (PR), PFS was 7.7 months. He received targeted treatment and chemotherapy subsequently till the last follow-up date.Patient 3, a 40-year-old female, stage IVB with EGFR exon 20ins(V774_C775insHV). The first-line treatment was pemetrexed and carboplatin plus pembrolizumab, she achieved 7.7 months of stable disease(SD). Patient 4, a 57-year-old female, stage IVB with EGFR 20 ins (D770del) , she received first-line pemetrexed and carboplatin plus pembrolizumab. After 1 month, she suffered dyspnea and CT scanning showed massive pericardial effusion and bilateral pleural effusion. Patient 5, a 43-year-old male, stage IVB with EGFR 20 ins (A767-V769up). After the progression of first-line treatment of osimertinib, he received nab-paclitaxel, carboplatin, bevacizumab and durvalumab. The best response was PR. And so far he have been treated with osimertinib plus durvalumab.
Conclusion
We suggested that chemotherapy plus immunotherapy may become a potential treatment for patients with EGFR exon 20 insertion positive advanced lung adenocarcinoma. It is not clear whether this regimen is appropriate for each of the 20 insertion sites. The therapeutic combination will need more real-world evidences.
